Provider Demographics
NPI:1346572930
Name:CHILD, FAMILY AND INDIVIDUAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:CHILD, FAMILY AND INDIVIDUAL THERAPY SERVICES LLC
Other - Org Name:CENTER FOR CHILD AND FAMILY THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:970-266-8644
Mailing Address - Street 1:155 W HARVARD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5200
Mailing Address - Country:US
Mailing Address - Phone:970-266-8644
Mailing Address - Fax:
Practice Address - Street 1:155 W HARVARD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5200
Practice Address - Country:US
Practice Address - Phone:970-266-8644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 5553251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health